Epilepsy: Much feared body disorder is Curable With Medicine

New Delhi/ Bhopal: Epilepsy or seizure is a neurological condition in which the brain gets uncontrolled or unorganised electrical discharges. These can cause a change in behaviour of a person and lead to repeated and unpredictable seizures. Anyone can develop epilepsy and it can affect both men and women of all ages. The episode of seizure lasts for a few seconds to a minute at maximum.
In majority of cases, genetic factors are a major reason for seizures though in some cases there may not any justifiable cause.

Epilepsy accounts for a significant proportion of the world affecting 50 million people worldwide.
Each year, an estimated 5 million people are diagnosed with epilepsy.
In India, more than 10 million patients are suffering with epilepsy, 20 per cent out of 50 million worldwide.

Epileptic seizures :The brain normally has electrical currents in the brain, which help the brain to control different functions of the body. Sometimes these electrical currents increase suddenly; this is conducted to the body and produces actions and behaviours, which are called seizures.
There are many different types of seizures depending on the area of the brain where the seizures occur. They can manifests as:
– Impairment or loss of consciousness

– Abnormal motor activity (example, jerking)

– Behavioral abnormality

– Abnormal sensations
Seizures occur because of many reasons like:
– Metabolic events
– Brain Infections
– Drug intoxication/side effects
– Hypoxia or lack of oxygen delivery to the brain

– Head Injury

– Febrile seizures or seizures due to fever
Epilepsy on the other hand means recurrent seizures without an immediate precipitating cause.

Diagnosis :
Diagnosis of sy is clinical Investigations or tests are used only to support the diagnosis. Clinical diagnosis means asking for details of the event, when

and how the event started and progressed, how long was it and how it ended.
Besides this, birth, development and family history are also taken in detail.

Investigation Required:
MRI of the brain and EEG (Electroencephalogram) are important tests. Other tests of blood, biochemistry tests and genetic testing may be required, and will be decided by the doctor.

EEG : An EEG is an electrical recording of the brain currents. Just like you have an ECG for the heart, EEG studies currents of the brain. But it is much more complicated, and has many channels or lines. The procedure typically takes 30 minutes to one hour, but can be done for longer periods, depending on the case. It gives information about the type of epilepsy and can suggest what type of treatment would be best. The first EEG can be normal in about 40-50 percent of the people with epilepsy. It may become abnormal only when a seizure is occurring. Repeating an EEG 2 or 3 times may be required sometimes to get a positive report.
Also, about 10% of normal people may have an abnormal EEG.

An MRI is a detailed image of the brain. It shows the structure of the brain, and can suggest why seizures are occurring. Many types of MRI are available. The 3 Tesla MRI may sometimes be required. The MRI may be normal in many cases of epilepsy, usually the genetic epilepsies.

Role of genetics in epilepsy : The genes of the child may be abnormal, and this may cause epilepsy. The genetic abnormality may be inherited, but may also occur in the child for the first time.
Epilepsy may be associated with developmental delays or intellectual disability, cerebral palsy, autism, learning disorders and behaviour problems.

Treatment :The child will be given treatment with anti-seizure drugs. There are many types of drugs. The drug given will depend on the seizure type and the underlying cause.
It is to be noted that seizures can occur even if the medicines are going on. Many times, the parents stop the drug suddenly or forgive to give the dose. At that time, seizures may occur. At other times, the child probably needs a higher dose of the drug, and this will be increased by the doctor according to the requirement. Sometimes multiple drugs are required for control.
The treatment is typically given for 2-3 years seizure free period. In some children, the duration may be shorter: 1-1.5 years. Kindly note that the medicines do not cure the epilepsy, they only suppress the seizures. The only way to find out is to stop the drugs and see. The medicines have to be stopped gradually.

Recently, the concept is that the epilepsy is considered cured only if there are no seizures for 10 years, and of this at least 5 years should be without medicines.

Seizure precautions:These are precautions which are taken either to avoid situations that precipitate seizures in certain types of epilepsies, example, flickering lights in some epilepsies.
Prevent injuries during a seizure, example, swimming, cycling, swings, or going near fire.

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• Dr. Naresh Purohit (RCH), MD, DNB, DIH, MHA, MRCP(UK), is an Epidemiologist, and Advisor-National Communicable Disease Control Program of Govt. of India, Madhya Pradesh and several state organizations. He is also an Executive Member-Indian Academy of Neurology.